Mark T. Murphy, DDS 

Let’s be candid, obstructive sleep apnea is a pervasive issue, and frankly, it’s underdiagnosed. We, as dentists, hold a unique position in identifying this. Dentists should be screening for airway issues. Why? Because we’re in the oral cavity, the very nexus of the airway. We aren’t expected to treat every case, but we are obligated for sleep apnea screening. It’s about patient well-being, and it’s about recognizing the impact of our interventions on overall health.

The Importance of Early Sleep Apnea Diagnosis from a Dental Perspective

As dentists, we understand the intricate link between oral health and systemic health. Sleep apnea, if left unchecked, can significantly impact our patients’ overall health, leading to complications that extend far beyond the dental chair. Early sleep apnea diagnosis not only benefits our patients but also enhances our ability to provide comprehensive care.

Initial Sleep Apnea Screening: Practical Tools and Techniques

Is you patient spending $30,000 on a comprehensive restorative plan that keeps the anatomical box that surrounds their tongue the same size? A constricted “box” can lead to airway obstruction. If the tongue is a size seven in a size five box, the patient is spending a lot of money to still have a compromised airway.

This “tongue box” analogy highlights the importance of considering the relationship between tongue size and the surrounding anatomical space. I use the following tools and techniques to assess the entire airway during sleep apnea screening in my practice.

Visual Observations

I examine the patient for signs of potential airway limitations and obstructions. During visual assessments, I pay close attention to the size and position of the tongue, the arch form, and the overall dimensions of the oral cavity. These observations can provide valuable insights into potential airway limitations. I look for macroglossia, tonsillar hypertrophy, retrognathia, and GERD. Dental erosion may be an indicator of underlying obstructive sleep apnea, so I’ve integrated questions about GERD into our patient history.

Enhanced Medical History

I recommend integrating the STOP-BANG Questionnaire and Epworth Sleepiness Scale (ESS) into your medical histories for sleep apnea diagnosis. The STOP-BANG Questionnaire is a rapid, efficient tool for risk stratification and explaining to patients their need for further evaluation. Integrate this questionnaire into your patient history. The Epworth Sleepiness Scale is not a definitive diagnostic tool but offers valuable insights into daytime sleepiness. In addition to daytime sleepiness, ask patients about morning headaches, witnessed apnea episodes, cognitive dysfunction, and snoring.

RestFull Software

I use RestFull software tools to provide visual risk assessments and aid in patient education and referral decisions. RestFull provides dentists with tools, education, and support to assess and manage obstructive sleep apnea (OSA). Their cloud-based software streamlines workflows, including patient screening and coordination with physicians. They also offer training to help dental teams confidently address OSA, along with support for medical billing. RestFull equips dentists to offer alternatives like oral appliance therapy for patients who struggle with CPAP machines, promoting effective and comprehensive sleep apnea care.

Imaging for Sleep Apnea Diagnosis

Both CBCT (Cone-Beam Computed Tomography) scans and pharyngometry have their roles in assessing obstructive sleep apnea (OSA), but they come with specific strengths and limitations for sleep apnea diagnosis.

CBCT Scans provide detailed 3D imaging of the upper airway, making them highly valuable for anatomical assessments. They can help identify areas of airway narrowing and calculate airway volume, which is useful for screening and treatment planning. However, CBCT scans are not predictive of treatment outcomes but can be used alongside other diagnostic tools.

Pharyngometry is a non-invasive technique that uses acoustic reflection technology to measure airway volume and cross-sectional areas, important for sleep apnea diagnosis. Instead of producing a traditional visual image, it generates a graphical representation of the airway, displaying changes along its length. This data helps clinicians assess airway size, stability, and potential obstructions but is not predictive of treatment outcomes. It can be used alongside other diagnostic tools for obstructive sleep apnea.

Recent Advances in Assessing Obstructive Sleep Apnea

Recent advancements in detecting obstructive sleep apnea (OSA) have focused on improving accessibility, accuracy, and patient comfort. Some notable developments are AI-powered tools to analyze data from sleep studies, portable and user-friendly devices for home-based OSA detection, and wearable technology such as smart watches and fitness trackers to monitor sleep patterns, oxygen levels, and heart rate variability.

Specialist Referral for Collaborative Care

Dentists are uniquely positioned to recognize signs of obstructive sleep apnea (OSA), but effective diagnosis and treatment require a team approach. While tools like CBCT scans, pharyngometry, risk-assessment questionnaires, and smart watches provide valuable screening insights, they are not substitutes for medical evaluation. A multidisciplinary approach, including collaboration with sleep specialists, pulmonologists, neurologists, and ENT specialists, ensures patients receive accurate diagnoses and appropriate treatment.

Polysomnography (a sleep study) remains the gold standard for confirming OSA, guiding treatment options such as CPAP therapy, oral appliance therapy, or surgical interventions. By educating patients on the importance of sleep studies and providing seamless referrals, dentists can improve adherence to getting a medical diagnosis and guidance.

Building strong referral networks doesn’t just enhance patient care—it elevates the role of airway dentistry in a broader healthcare ecosystem. When we take an active role in facilitating diagnosis and treatment, we help patients reclaim their sleep, health, and quality of life.

Advance your Expertise in Airway Dentistry

Our commitment to patient well-being extends beyond restorative dentistry. By incorporating effective screening protocols and fostering collaborative relationships with medical specialists, we can significantly impact the lives of our patients. Let’s embrace our role in identifying and managing sleep-disordered breathing.

• Educate patients on symptoms such as snoring, morning headaches, cognitive dysfunction, and witnessed apneas.
• Educate patients on the benefits of sleep studies (polysomnography) for definitive diagnosis.
• Facilitate referrals to qualified sleep specialists.
• Stay informed about advancements in diagnostic technology to enhance your practice.

In my next blog, I’ll discuss Oral Appliance Therapy for Sleep Apnea Treatment. For an in-depth webinar presentation with visuals, go to Pankey Webinar: Airway Dentistry.